Friday, 24 April 2015

Cognitive impairment and voting: the capacity to be heard

The upcoming
election is an opportunity for the population to have their say in the future
running of the country. We live in a democracy and the right to vote feels
fundamental. But two
thirds of all people in the UK with learning disabilities do not vote. Many
may not even know that they are entitled to a vote. UK-based statistics are not
available but research suggests that for individuals who have cognitive
impairments of other causes (e.g dementia, brain injury), voting
rates may be similarly low.

Though there
are many jokes about the intellectual functioning of the average voter abound
in the run-up to an election, the reality is that voting eligibility is not
determined by intellectual ability. It appears though that this is not common
knowledge. Many health and social care professionals (see here and here) are not fully
aware that their clients are actually allowed to vote. The presence of a cognitive impairment may
make the process of voting challenging, but is this really sufficient reason to
not support people from doing so? Assumptions about whether someone can and
should vote may be informed by the ideas around their mental
capacity.

The Mental
Capacity Act (2005) supports adults who have an ‘impairment of or disturbance
in the functioning of mind or brain’, who may lack the ability to make a
decision. Capacity is assessed on an individual decision-basis, and with all
available support the individual must demonstrate that they can do the
following:

Understand
the relevant information, including understanding the likely consequences of
making the decision.

Retain that
information.

Use or weigh
that information as part of making the decision.

Communicate
their decision.

At face-value,
the notion of assessing capacity to vote appears sensible. But when one
considers how we might judge ability to ‘understand and retain’ the information
relevant to the decision to vote, the process is not straightforward. Which
information is most relevant? Would we expect someone to have read all of the party
manifestos and to be able to recall this information? How would we expect
someone to explain the ‘likely consequences’ of their voting choice? We
certainly do not apply these criteria to people without disabilities and I
imagine few could fulfil this criteria.

The available
advice around voting capacity is often lacking or conflicting. The Mental
Capacity Act explicitly does
not cover voting. It is however relevant
to the decision of appointing a proxy. Intellectual functioning is not
mentioned in the voting eligibility criteria set out by Government services
or the Electoral
Commission. The latter considers that votes must
not be subject to any legal incapacity to vote’, and that ‘A lack of mental capacity is not a
legal incapacity to vote’. The legal position from 2006
has been that ‘a person is subject to a legal incapacity to vote by reason of
his mental state’ was abolished. On the other hand information provided by the
Citizen’s Advice Bureau states that ‘people who
have a severe mental illness and are unable to understand the voting procedure’ are ineligible to vote. An editorial in the
British Medical Journal suggested ‘it seems inevitable that doctors will be asked
to assess capacity to vote’ and expressed the need for advice. It may be
necessary for voting information to explicitly state that a cognitive impairment
does not preclude someone from voting to dispel eligibility myths.

My own experiences of working within a rehabilitation service for adults
with acquired brain injury has highlighted to me the lack of awareness around
voting eligibility and also issues of accessibility. Many of the service-users
have significant cognitive impairments as well as communication and sensory difficulties.
Our attention was drawn to the issue at the start of the year, at which point
none of the residents where I work were actually registered to vote. Whilst all
staff are committed to supporting social inclusion, we realised we had never
considered voting as part of this. Inquiries to local candidates requesting
clarification on eligibility and accessible information generated no responses.
After informing ourselves of some of the information above, we made service-users
aware of the election and their right to vote. For those interested, we have
supported them to register. For many of the service-users, who are grappling
with the consequences of their brain injury, the election does not appear to be
a particular priority. However I do see it as within our remit, as
professionals who seek to empower, to make the people we support aware of their
rights and to actively promote these. I have been surprised by local
politicians’ lack of interest in engaging with our service-users, who in
addition to being a marginalised group, are also “untapped” voters. Whilst most
people complain about the amount of election material they receive through
their door, we have yet to receive any unsolicited information.

Given that people
who have a cognitive impairment are legally entitled to vote, how can we assist
them to understand and be involved in the process of voting? We need to promote
voting, whilst also ensuring that individuals are not unduly influenced or
exploited by others. Every
Vote Counts campaigns to increase the rates at which people with learning
disabilities are voting and encourages political parties to take note. At the
time of writing the Liberal
Democrats and the Green
Party have released easy read
accessible manifestos. Dementia-related organisations have also produced some
advice regarding voting (see here
and here).

More however
needs to be done. The lack of awareness around voting eligibility represents
one of the many ways that people with disabilities are unconsidered and
alienated within our society. As frequent users of health and social care
services, people with disabilities deserve the right to contribute to decision
making that may have a considerable impact on them. If politics appears too abstruse for someone
with a cognitive impairment to follow, then this is a fault for political parties
to address. Voting is not a matter of intellectual ability but of civil rights
and we must promote inclusion for all.

Dr Alexandra Richards is a clinical
psychologist working in neurorehabilitation. You can follow her on Twitter @allyfrichards.

About the Salomons Centre

The Salomons Centre for Applied Psychology in Tunbridge Wells, England. We are part of the Canterbury Christ church University Department of Psychology, Politics and Sociology. We run training courses in Clinical Psychology and CBT and also practice improvement programmes for child and adolescent mental health services. On this site staff and trainees in the Department write about a wide range of issues related to applied psychology, psychological therapies, policy and health service development.